Rozalina McCoy, MD, an endocrinologist at the Mayo Clinic in Rochester, Minnesota, and colleagues reviewed information for 31,542 adults (median age, 58 years). All had stable and controlled type 2 diabetes without insulin treatment, and none had a prior history of severe hypoglycemia. Intensive treatment was defined as use of more glucose-lowering medications than recommended by practice guidelines per glycated hemoglobin level.

The researchers found that the risk-adjusted probability of intensive treatment was 25.7% in patients with low clinical complexity and 20.8% in patients with high clinical complexity. In patients with low clinical complexity, the risk-adjusted probability of severe hypoglycemia during the subsequent 2 years was 1.02 and 1.30% with standard and intensive treatment, respectively. In patients with high clinical complexity, the risk-adjusted probability of severe hypoglycemia increased from 1.74% to 3.04% with standard and intensive treatment, respectively.

"This means that 3 out of 100 older or clinically complex patients with diabetes who never had hypoglycemia before, whose glycated hemoglobin is within recommended targets, and who are not on insulin, will experience a severe hypoglycemic episode at some point over 2 years," McCoy said in a Mayo news release.